OCULAR TRAUMA.

FOREIGN BODIES IN THE

EYE.
 INTRODUCTION

Although the eye is well protected by the orbit,

it may yet be subject to injuries.

Forms of injury include:

- Foreign bodies
- Blunt trauma
- Penetrating trauma
- Chemical and radiation injuries

Risk factors:
- Gender : 75%-80% of them are in males
- Age: more in children and young age group
- Occupation : construction, industry
- Sports : boxing , racket sports
- Motor vehicle accidents
 CORNEAL FOREIGN
BODIES
Corneal foreign body is foreign
material on or in the cornea, usually metal,
glass, or organic material.
Symptoms
Foreign body sensation, Tearing,
History of trauma ,photophobia , pain , red
eye
Signs
Corneal foreign body with or without
rust ring, edema of the lids, conjunctiva,
and cornea, foreign body can cause
infection and/or tissue necrosis.
Workup
1.History and document visual acuity.
One or two drops of topical anesthetic may
be necessary to control pain.
3.Slit-lamp Examination: If there is no
evidence of perforation, evert the eyelids
and inspect for foreign bodies.
4.Dilate the eye and examine the
vitreous and retina
 CORNEAL FOREIGN
BODIES

Treatment

1.Apply topical anesthetic, remove the foreign body with a

spud or forceps at a slit lamp. If multiple superficial foreign
bodies, its easier to remove with irrigation.
2.Remove the rust ring. This may require an ophthalmic drill.
3.Measure the size of the resultant corneal epithelial defect.
4.Treat as for corneal abrasion.
 BLUNT TRAUMA

Blunt impact may damage the structures at the front of

the eye (the eyelid, conjunctiva, sclera, cornea, iris, and lens)
and those at the back of the eye (retina and optic nerve).
If a small objects hits the area the eye, itself may take
most of the impact.
If a large object hits the eye most of the impact is
usually taken by the orbital margin. Such an impact may also
result in damage to the orbit (blow-out fracture).
 PENETRATING TRAUMA

When a foreign body passes through the ocular

coat of the eye, this will cause damage in the
ocular structures, and in some cases the
foreign body may also be retained in the eye.
Penetrating injury of the eye represents a
major threat to vision in the workplace, home
and school.
 LID LACERATIONS

Eyelid Lacerations: Cuts to the eyelid caused by trauma

Superficial Lacerations can be usually treated in the emergency
room under local anesthesia.
 SUBCONJUNCTIVAL
HEMORRHAGE
Is bleeding underneath the conjunctiva. The conjunctiva contains
many small, fragile blood vessels that are easily ruptured or broken.
When this happens, blood leaks into the space between the conjunctiva
and sclera.
Symptoms Red eye, may have mild irritation, usually
asymptomatic
Signs Blood underneath the conjunctiva, often in a sector of the
eye. The entire view of the sclera may be obstructed by blood.
Causes Valsalva (e.g., coughing or straining), Trauma, Bleeding
disorder. Workup
-History: Bleeding or clotting problems? Medications (e.g.,
aspirin, warfarin)? Eye rubbing, trauma, heavy lifting, Valsalva? Recurrent
Subconjunctival Hemorrhage? Acute or Chronic cough (COPD)?
-Check Vital signs
-History of recurrence or bleeding problem
-Positive Orbital signs: CT scan with and without contrast
 SUBCONJUNCTIVAL
HEMORRHAGE
Ocular Examination: Rule out a conjunctival lesions, Check IOP, and
Check extraocular motility.

In traumatic cases you should rule out:

-Ruptured Globe (Abnormal deep ant. Chamber, Significant SCH,
Hyphema, Vitreous hemorrhage, or prolapse of uveal tissue) .
-Retrobulbar Hemorrhage (Exophthalmus, Increased IOP, and
chemosis)
-Orbital Fracture (Limited extraocular eye motility, eno- or exo-
phthalmus, preiorbital crepitus, paraesthesia.
 LIDHYPHEMA
LACERATIONS
Blood in the Anterior Chamber
Causes: hyphemas are frequently caused by injury
blunt trauma, and it may partially or completely block
vision.
Complications:1.hemosiderosis 2.hetrochromia 3.blood
accumulation may also cause elevation of the intraocular
pressure.
Symptoms
Pain, Blurred vision, History of blunt trauma
Signs
Blood in the Anterior Chamber. Gross layering or clot
or both, usually visible without a slit lamp.
 HYPHEMA

Workup
1. History: Mechanism of injury, approximate time and
day, time of visual loss, Medications (Aspirin, NSAIDs, Warfarin),
History or family history of sickle cell disease/traits.
2. Complete Ocular Examination
3. CT scan of the orbit

Treatment
For all patients
1. Complete bed rest or hospitalization
2. Place a shield over the injured eye. Elevation of the
head of the bed by approximately 45 degrees (so that the
hyphema can settle out inferiorly and avoid obstruction of vision,
as well as to facilitate resolution
3. Atropine
4. Mild analgesics
5. Topical steroids drops (Traumatic iritis develop 2-3
days)
6. NO aspirin or NSAIDs
 SUBLUXATION /DISLOCATION OF THE
LENS
Definition:
Subluxation: Partial disruption of the zonular fibers; the lens is
decentered but remains partially in the pupillary aperture
Dislocation: Complete disruption of the zonular fibers; the lens
is displaced out of the papillary aperture.
Causes
1. Trauma most common cause
2. Marfan Syndrome
3. Homocystinuria
Symptoms
Decreased vision, double vision that persists when covering
one eye (monocular diplopia)
Sign
Decentered or displaced lens,. Marked astigmatism, Cataract,
Angle-closure glaucoma as a result of pupillary block, acquired
high myopia, viterous in the ant. Chamber, asymmetry of the ant.
Chamber depth

Treatment In dislocation; surgical intervene

 CHEMICAL BURN

Treatment should be instituted immediately, even before

testing vision.
Emergency treatment:
1-copious irrigation of the eyes, preferably with saline or
ringer lactate.
Dont use acidic solutions to neutralize alkalis or vice
versa.
Pull down the lower eyelid and evert the upper eyelid to
irrigate the fornices
2-irrigation should be continued until neutral PH is
reached.
The volume of irrigation fluid required to reach neutral PH
varies with the chemical and the duration of the chemical
exposure
For mild to moderate burns (during and after irrigation):
-cycloplegic
-topical antibiotic
-oral pain medication
-if increase IOP use drugs to reduce it (acetazolamide,
 CHEMICAL BURN

For severe burns (Treatment after irrigation):

Admission to the hospital Lysis of conjunctival adhesion
Debride necrotic tissue
Topical antibiotic
Topical steroid
Antiglaucoma medication if the IOP is increased or cant be
determined
Frequent use of preservative free artificial tear
Other consideration:
Therapeutic contact lenses, collagen, amniotic membrane
transplant
IV ascorbate and citrate for alkali burns
If any melting of the cornea occurs, collagenase inhibitors
may be used
If the melting progresses an emergency patch graft or
corneal transplat may be necessary.